Is There Room For Dying Well In Singapore?

There’s much talk about the quality of life in this country but less about the quality of death. Is Singapore a good place to die well?
Is There Room For Dying Well In Singapore?

What is a good death to you?

For some, it is painless and devoid of suffering. For others, to die well means to leave the world with no regrets, their last wishes fulfilled.

No two dying patients (and their families) have the exact same needs, says Ms Sim Lai Kiow, a veteran nurse clinician who has spent the past 12 years specialising in palliative care, or care given to improve the quality of life for terminally ill patients and their families.

Earlier this year, one of Ms Sim’s patients had expressed a wish to see her daughter get married. Ms Sim, who works at Khoo Teck Puat Hospital (KTPH) and has 40 years of experience in nursing, assessed that the patient might not live long enough to witness the actual wedding.

Working with the hospital staff, the patient’s daughter and her fiancé brought forward the wedding ceremony and held it at the Lily Room. The Room is a special facility in KTPH where terminally ill patients can live out their last days peacefully – that means no intimidating equipment counting down to their death or painful treatments prolonging their suffering. There are 10 such rooms in the hospital.

“Got pastor, flower girl and boy, and live guitar music some more [sic]. Then the couple walked into the room and exchanged rings,” Ms Sim recalls, and shows a few photos that she had taken with her smartphone of the ceremony. “It was quite beautiful when [the patient] smiled. Her smile was so sweet.” The patient passed away days after.

Is There Room For Dying Well In Singapore?
Happy Coffins
Some of these cheery artworks on the theme of death are used in the “Happy Coffins” project. It is part of the Lien Foundation’s Life Before Death initiative to encourage people to see and converse about death in a more celebratory and empowering light. Find out more at

Palliative care in Singapore

Unfortunately, not all terminally ill patients in Singapore get to enjoy such meaningful last moments, if the 2010 “Quality of Death” Index – devised by the Economist Intelligence Unit and commissioned by Singaporean philanthropic organisation Lien Foundation – is anything to go by. Measuring the quality of palliative or end-of-life care around the world, the Index ranked Singapore 18th among 40 countries (UK topped the list).

Recognising the need to boost palliative care given our ageing population, the Singapore government launched its National Strategy for Palliative Care in 2011. Its aims include promoting awareness of Advance Care Planning and ensuring that all students in undergraduate and diploma professional healthcare courses receive palliative training.

There has been some progress so far. According to the Lien Foundation, the number of certified palliative care specialists in Singapore has increased from 17 in 2009 to 41 currently, and the number of patients receiving home palliative care has jumped from 1,700 in 2009 to more than 5,000 now.

Demand for such care is expected to grow to more than 10,000 per year in 2020 and training healthcare professionals is crucial, said Dr Amy Khor, Senior Minister of State (Health), in a recent speech. At KTPH, Ms Sim has been tasked to draft a training programme on end-of-life care for all healthcare staff.

But “greater awareness of end-of-life care and the value of such care is still much needed,” says Mr Gabriel Lim, Programme Manager, Lien Foundation.

Is There Room For Dying Well In Singapore?
Both Sides, Now
The Both Sides, The event invited members of the public to think and talk about death.

Let’s talk about death

Raising awareness on dying well often begins with talking about death. But in Asian societies like Singapore, that is a taboo topic.

Or is it?

Both Sides, Now was a multidisciplinary immersive arts experience held at KTPH last November. Showcasing artworks (including installations, films and theatre performances) on end-of-life issues and with the help of volunteers, it aimed to get people talking about death. And some Singaporeans did, says Ms Ngiam Su-Lin from ArtsWok, one of the exhibition’s co-producers.

She shares with Challenge that 75% of over 200 participants polled said they were inspired by the seven-week event to act on what they learnt, such as starting conversations with their loved ones about death. About 8,000 attended the event.

“The topic of death may not be as taboo as we think. It may be that people just do not have the opportunity to talk about it in a safe [environment],” which the event probably provided, says Ms Ngiam. “Maybe talking to a stranger (a volunteer) [about death] is easier than talking to your family members. It’s not so emotionally loaded.”

Ms Eileen Cheah Lilian, Nurse Manager (geriatric ward) at KTPH, was one of those who found the courage to share with her family on such issues after visiting the exhibition. The first person she approached was her mother.

“Previously I didn’t even dare to talk to my mum about death. And we are both nurses!” says Ms Cheah. “I talked to my kids, aged 8 and 10, also, [saying], ‘one day something may happen to Mummy. You need to be independent.’ They are open [to the topic].” She then had a similar conversation with her husband, and is now starting with her parents-in-law.

Empowering patients

In her nine years at the geriatric ward, Ms Cheah has seen how family members, especially children with elderly parents, struggled to accept the impending demise of their loved ones. Some resorted to hiding from the patients their actual conditions; some insisted on subjecting the patients to painful treatments even when chances of recovery were slim or even zero.

Thus, sometimes what the patient’s children decide to do may not be best for the patient, she notes. She believes that patients need to have the power to decide how their last moments should be spent.

With plans to take Both Sides, Now to the heartlands by year-end, more people will have the chance to reflect on death and be empowered to prepare a quality death for themselves. Perhaps then Singapore would become an ideal place to die well.

Advance Care Planning (ACP)

This initiative encourages open and early communication among patients, family members and healthcare professionals on the patients’ future healthcare options. Trained ACP facilitators guide the discussions. For more info, email or call KTPH Mainline 6555 8000.

    May 15, 2014
    Chen Jingting
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